If You Knew You Could Reduce Readmissions by 32% via Telehealth, Would You Do It?
Of course you would. These strong results are courtesy of the Veterans Administration, who, via their extensive telehealth program, reduced readmissions for in-home telehealth participants by 32% and reduced the number of bed days for telehealth participants by 42% in FY 2014, according to an iHealth.org report. When I saw these jaw-dropping statistics, I was reminded of one of the most personally influential books I’ve ever read about healthcare, Best Care Anywhere: Why VA Health Care Would Work Better For Everyone, by Phillip Longman.
This slim and highly readable book, explains what is behind the best results in the country, (yes, the best based on 8 highly verifiable measurements of results), and to save you the read, though I recommend reading the book, it boils down to two factors:
Consistent longitudinal care supported by Electronic Health Records -- The cohort of patients has been in the same healthcare system since they were eighteen. Thus physicians can look up histories of patients, illnesses and medicines for their whole lives.
Consistent practice of evidence-based protocols -- So it turns out that sometimes having less money is a good thing. No stents when aspirin will do--exceptions to treatment are very hard to come-by.
So while the negative press headlines today justifiably focus on the time to enrollment and appointments for returning vets, there is good news once you’re in the system. And now, the VA has leaped ahead of the private sector, who is struggling to work out compensation models and scheduling practices for the wide adoption of telemedicine elsewhere.
In mHealth we have become conditioned to having scant evidence for the success of technology use in the care system. Many pilots are for less than 100 patients. mHealth pilots seem to stymie IRBs across the country. This is why these results are so significant. More than 690,000 Veterans participated for a combined 2,000,000 telehealth appointments.
- 379,000 veterans participated in store-and-forward telehealth;
- 248,000 veterans received some sort of clinical video care;
- 156,000 veterans received in-home telehealth services;
- 108,000 veterans received mental health care via telehealth, with 336,000 total visits;
- 4,000 veterans have clinical video technology installed in their homes; and
- 44% of veterans living in rural areas have received some form of telehealth services.
In addition to the impressive drops in readmissions, the program is very popular. That report further stated that the VA's clinical video telehealth program received a 94% satisfaction rating in a FY 2014 survey of roughly 10,000 veterans, and store-and-forward tele-dermatology received a 92% patient satisfaction rating. Meanwhile, tele-retinology racked up a 94% patient satisfaction rating, with an additional survey of 200,000 home telehealth participants boasting an 85% patient satisfaction rate.
Finally, if you look at the VA budget for 2015, Telehealth accounts for a mere .33% of total costs, even as telehealth visits grows 22% a year.
So what are we waiting for in the rest of the country? Let’s get on with it--it works!